Reporting Party. Enter the mandated reporter's name, title, category (from PC section 11165.7), business/agency name and address, daytime telephone number, and today's date. Check yes/no whether the mandated reporter witnessed the incident. The signature area is for either the mandated reporter or, if the report is telephoned in by the mandated reporter, the person taking the telephoned report.
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Samples: www.millbraeschooldistrict.org, www.millbraeschooldistrict.org, www.millbraeschooldistrict.org
